Prophylaxis of postoperative nausea and vomiting with ondansetron, metoclopramide, or placebo in total intravenous anesthesia patients undergoing laparoscopic cholecystectomy.
OBJECTIVE
To compare total intravenous anesthesia (TIVA) with ondansetron, and metoclopramide in preventing postoperative nausea and vomiting (PONV) in laparoscopic cholecystectomy patients.


METHODS
A prospective randomized double-blinded study was performed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia in 2007. Seventy-five patients scheduled for laparoscopic cholecystectomy under TIVA were randomized to receive either: metoclopramide 10 mg (n=25), 4 mg ondansetron (n=25), or placebo (n=25) at the end of surgery. Postoperative nausea and vomiting episodes, analgesic supply, rescue medication, adverse events, and patient satisfaction were collected over 24 hours.


RESULTS
Nineteen patients developed PONV. The frequencies of PONV were equal for the 2 groups (28%), and lower among the ondansetron group (20%) (p>0.05). Female gender, lengthy surgery, and longer hospital stay were associated with more frequent PONV regardless of the study group (p<0.05). Patient's satisfaction was more frequent among the ondansetron group (p>0.05). Morphine consumption was associated with more PONV, but it was statistically significant only in the placebo group. There was no difference between the 3 groups with regard to the VAS pain score, cardiovascular parameters, or oxygen saturation.


CONCLUSIONS
It is unlikely that a single technique or drug will ever be effective in treating emesis under all surgical circumstances. Therefore, a multimodal regimen incorporating avoidance of emesis triggering factors, and administration of antiemetic medications is recommended.
Kaki
Abdullah M
AM
Department of Anesthesia, King Abdulaziz University Hospital, PO Box 2907, Jeddah 21461, Kingdom of Saudi Arabia. amkaki@yahoo.com
Abd El-Hakeem
Essam E
EE
D000328:Adult; D000771:Anesthesia, Intravenous; D000932:Antiemetics / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D017294:Ondansetron / Q000627:therapeutic use*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies
D000932:Antiemetics; D017294:Ondansetron; D008787:Metoclopramide